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Beach Chair Position

 

 

Background

 

  • Beach chair or sitting positioning

  • Used for post fossa craniotomy, post c-spine surgery, shoulder surgery

 

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Physiologic Effects of Sitting Position ​

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  • CNS

    • ↓  cerebral perfusion

      • correct MAP for hydrostatic diffn b/w BP cuff  & brain; place transducer @ level of external auditory meatus if art line

        • 1 cm rise = 0.75 mmHg drop in MAP

      • Compounded by effects of GA & sitting position on cerebral autoregulation

    • Possible cerebral O2 desaturation (unrelated to hemodynamics)

  • CVS

    • Venous pooling in lower extremities -->  ↓ preload, SV, MAP, CO (~20%), & CPP

      • Mitigated w/ IV fluids, flexing hips w/ legs elevated, compression stockings, gradual head elevation

  • Respiratory

    • ↑ FRC, lung compliance

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Potential Complications 

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  • Nerve injuries

    • Brachial plexus, ulnar nv, & sciatic nv can be stretched/compressed

    • Spinal cord injury - if sig neck flexion

  • Pressure injury over ischial tuberosity

  • Excessive neck flexion - vascular obstruction in neck, kinking/obstruction of ETT/SGD, tongue/oropharyngeal swelling

  • Venous air embolism

  • Pneumocephalus

  • Stroke, ischemic brain injury, and death

 

References

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  • Breyer, KEW, Roth, S. (2020) Chapter 34: Patient Positioning and Associated Risks. In Miller’s Anesthesia, 9th Ed. Elsevier. p1079-1112.e6

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